title: [Analysis of difficult intubation factors in bariatric surgery. Influence of the choice of neuromuscular blocker on the availability of sugammadex].
abstract: OBJECTIVE
  To determine the incidence of difficult tracheal intubation (DTI), as well as predictive factors for DTI and what influences the choice of the neuromuscular blocking agent (succinylcholine or rocuronium).
  
  
  METHODS
  This is an observational, prospective study on consecutive bariatric surgery patients. Tracheal intubation was performed by direct laryngoscopy with a preformed tracheal tube. DTI was considered when there was a Cormack-Lehane classification of iii-iv or when it was necessary to apply the DTI algorithm, which consisted in the use of Frova guide, and Airtraq video-laryngoscope as second choice, and finally awaking the patient and sugammadex reversal if rocuronium was the selected neuromuscular blocking agent. Thereafter, tracheal intubation was performed using an awake fibroscopic technique
  
  
  RESULTS
  One hundred and sixty six patients were included. In one case, conscious fiberscope tracheal intubation was performed. Succinylcholine was selected for 14 patients, and rocuronium for 151 patients. Fifteen patients had a DTI (9%): in 4 Airtraq was deemed necessary. One patient received sugammadex to reverse neuromuscular blockade. Conscious tracheal intubation represented 1.2% (95% CI; 0.3-4%). DTI was associated with Mallampati score of 3-4 (odds ratio, 3 [95% CI; 1.37-6.8], sensitivity of 33%, specificity of 91%) and with thyromental distance<6cm (odds ratio, 4.8 [95% CI; 1.45-16]; sensitivity of 53%; specificity of 79%).
  
  
  CONCLUSIONS
  Rescue airway protocol with Frova and Airtraq avoided the use of sugammadex, except in one patient.
authors.affiliation: Servicio de Anestesiologia, Reanimació i Unitat de Dolor, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: M C
authors.initials: MC
authors.lastname: Montealegre-Angarita
authors.forename: S
authors.initials: S
authors.lastname: Llauradó-Paco
authors.forename: A
authors.initials: A
authors.lastname: Sabaté
authors.forename: E
authors.initials: E
authors.lastname: Ferreres
authors.forename: A
authors.initials: A
authors.lastname: Cabrera
authors.forename: I
authors.initials: I
authors.lastname: Camprubí
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000627:therapeutic use*; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000627:therapeutic use*; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D013390:Succinylcholine; D000077123:Rocuronium
keywords: Bloqueo neuromuscular; Intubación traqueal; Morbid obesity; Neuromuscular blockade; Obesidad mórbida; Sugammadex; Tracheal intubation